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Rapid Deployment Valve for Aortic Stenosis Ups Stroke Risk

RDV use linked to increased rates of pacemaker implantation, disabling stroke but not mortality

heart model

FRIDAY, April 13, 2018 (HealthDay News) -- For patients with aortic valve stenosis, treatment with a rapid deployment valve (RDV) is associated with increased rates of new-onset pacemaker implantation and disabling stroke, compared with conventional biological valves (CBVs), according to a study published in the April 3 issue of the Journal of the American College of Cardiology.

Stephan Ensminger, M.D., from Ruhr-University Bochum in Germany, and colleagues enrolled 22,062 patients who underwent isolated surgical aortic valve replacement using CBV or RDV between 2011 and 2015. Researchers used 1:1 propensity score matching to analyze baseline, procedural, and in-hospital outcome parameters for CBVs and RDVs. A total of 20,937 patients received a CBV, and 1,125 were treated with an RDV.

The researchers found that for patients treated with an RDV versus a CBV, there were significantly reduced times for procedure (150 versus 160 minutes), cardiopulmonary bypass (70 versus 83 minutes), and aortic cross clamp (44 versus 60 minutes; P < 0.001 for all). However, patients treated with an RDV showed significantly elevated rates of pacemaker implantation (8.8 versus 3.7 percent) and disabling stroke (2.2 versus 0.9 percent; both P < 0.001); in-hospital mortality was similar (2.2 versus 1.7 percent; P = 0.22). After propensity score matching, these findings persisted. Comparison of three RDVs showed statistically non-significant differences in pacemaker rates, but significantly different postoperative transvalvular gradients.

"In this large, all-comers database, the incidence of pacemaker implantation and disabling stroke was higher with RDVs, whereas no beneficial effect on in-hospital mortality was seen," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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